CASE NO.1
A 92-year-old woman presented with a 2-month history of branch retinal vein occlusion (BRVO) in her right eye and secondary vision loss. The patient had not been treated previously, and her vision in the right eye at presentation was counting fingers at 2 feet. On fundus photography and fluorescein angiography (FA; Figure 1), intraretinal hemorrhages were seen along with cotton wool spots along the inferotemporal arcade and the inferior macula. These findings are consistent with BRVO.

TREATMENT
Optical coherence tomography (OCT) at presentation demonstrated massive thickening with subfoveal serous retinal detachment (Figure 2). These findings precluded effective laser treatment at this time, so we chose to inject the patient with the intravitreal dexamethasone 0.7 mg implant (Ozurdex, Allergan, Inc.).

The patient returned for a follow-up visit 3 weeks later. On OCT, the macular edema (ME) was seen to have improved markedly, and the serous retinal detachment had resolved (Figure 3A). Her visual acuity remained the same as before injection with the dexamethasone implant (counting fingers at 2 feet), and her intraocular pressure (IOP) had remained stable (preinjection IOP: 14 mm Hg; postinjection IOP: 12 mm Hg).

At this visit, we applied focal grid laser in her right eye. The decreased edema allowed a more accurate treatment with less power to a smaller geographical area. Two months following laser treatment, the foveal architecture was restored (Figure 3B), and vision improved to 20/400. IOP at this follow-up visit was 18 mm Hg. At the most recent follow-up, her vision had improved to 20/100.

CASE NO.2
A 47-year-old man from Abu Dhabi presented with central retinal vein occlusion (CRVO) and ME in both eyes. The patient has severe hypertension from kidney disease. His history revealed vision loss for at least 7 months, and he had not received any prior treatment. At presentation, the patient's vision in the right eye was 20/400 with an IOP of 8 mm Hg and 20/70 in the left eye with an IOP of 8 mm Hg. The ME in both eyes is seen on OCT in Figure 4. Fundus photography and FA showed intraretinal hemorrhages consistent with CRVO and ME (Figure 5).

TREATMENT
We injected the intravitreal dexamethasone implant in the patient's right eye 2 weeks after presentation and in his left eye 3 days later. Two weeks following the right eye injection, visual acuity in his right eye improved to 20/50 and the ME decreased on OCT (Figure 6A). His IOP at 2 weeks was 10 mm Hg. At this visit we applied gentle focal grid laser for the subtle ME immediately outside the fovea in the right eye. The visual acuity in the left eye had improved to 20/50 with an IOP of 12 mm Hg and a decrease in ME (Figure 6B). Fundus photography and FA showed decreased vascular tortuosity and less intraretinal hemorrhaging in both eyes (Figure 7). We applied laser to the left eye 3 days later for mild residual ME.

Approximately 2 weeks after combination therapy with the intravitreal dexamethasone implant and laser in both eyes, the patient returned for follow-up. The patient's OCT scans showed significant improvement in ME (Figure 8).

Approximately 3 months later, the patient's vision had stabilized to 20/50 in both eyes with complete resolution of ME.